Healthcare Provider Details

I. General information

NPI: 1730012576
Provider Name (Legal Business Name): AVESI GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 CREEDMOOR RD STE 201
RALEIGH NC
27612-3813
US

IV. Provider business mailing address

11615 BUSY ST
NORTH CHESTERFIELD VA
23236-4059
US

V. Phone/Fax

Practice location:
  • Phone: 984-318-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOY RUSSELL
Title or Position: OWNER
Credential:
Phone: 984-318-9797